What is the interval for dose increases when initiating sodium valproate in this patient?

• A. Daily
• B. Every 3 days
• C. Every 7 days
• D. Every 2 weeks

Answer: (B)

Starting sodium valproate requires slow dose titration to reach the right level while giving time to monitor effects and safety. Because valproate levels rise with each increment and adverse effects can develop with rapid increases, adjustments are spaced out rather than made daily. Increasing the dose every 3 days allows trough levels to stabilize at the new dose and provides a window to watch for signs of toxicity (like liver effects, blood count changes, sedation, GI upset) and to assess seizure control or mood stabilization. A 3-day interval also fits the typical practice of starting at a low dose and stepping up gradually (e.g., 5–10 mg/kg/day) until the target range is reached. Shorter intervals risk toxicity before you can detect it, while longer intervals may leave seizures under-treated. Hence, increasing the dose every 3 days is the most appropriate interval.